Mirror mirror on the ward: who is the unfairest of them all? Reflections on reflective practice groups in acute psychiatric settings

Consultant psychiatrists in medical psychotherapy, adult psychotherapists, child and adolescent psychotherapists and clinical psychologists increasingly complement their direct therapeutic activity with applications of their psychotherapeutic thinking in acute mental health work through facilitating reflective practice groups for staff working in mental health teams. The authors offer their reflections on facilitating National Health Service reflective practice groups using the metaphor of a mirrored dialogue between patient and professional, and professional and institution as a basis for informing the development of reflective practice for colleagues. Their reflections are based on working on three acute in-patient wards, in a crisis resolution team and in community mental health teams. They describe the practicalities of setting up and facilitating reflective practice groups, and offer insights into some of the issues that arise in reflective practice groups. They conclude that these groups are mutually beneficial in forging links between psychotherapy professionals and professionals working in other disciplines and areas of mental health. Facilitating these groups often requires a challenging adaptation of technique, which will not suit all psychotherapists, as well as a wider understanding of organisational dynamics and the interplay between clinicians and management.     

Mobilizing self through short-term dynamic interpersonal psychotherapy: a preliminary report

Background: The key features of short-term dynamic interpersonal psychotherapy (STDIP) are outlined along with the background of its development. Preliminary data demonstrating functional improvement in a small case series of patients is presented.

Methods: Nineteen patients were evaluated at commencement and end of therapy in a pilot study. Instruments used were the Childhood Trauma Questionnaire (CTQ); Beck Depression Inventory (BDI); Brief Symptom Inventory (BSI); COPE (Coping Style Questionnaire); Relationship Styles Questionnaire (RSQ) and Social Adjustment Scale-Self Report (SAS-SR).

Results: This cohort had significantly elevated scores on the CTQ. They demonstrated substantial improvement on measures including the BDI, and several subscales of BSI, COPE, RSQ and SAS-SR.

Conclusions: The small numbers and naturalistic design preclude firm conclusions however the results suggest that STDIP can be used to successfully treat patients, notwithstanding a history of childhood trauma.     

Cognitive/Behavior Therapy for Agoraphobic Women

No abstract available for this article.     

Women Living with Traumatic Brain Injury

Abstract

Women living with Traumatic Brain Injury (TBI) typically experience social and emotional sequelae that can be effectively addressed in the context of a psychotherapeutic relationship. Traumatic Brain Injuries can affect the full range of human functioning, from activities of daily living to experiencing a coherent sense of self. In this article, we focus on two issues, social isolation and emotional functioning, that encompass a number of key challenges facing women with TBI and are common and fruitful foci of psychotherapy. Social isolation includes marginalization in multiple communities, the invisibility of cognitive disabilities, difficulties in interpersonal relationships, and difficulties in employment and access to transportation. Emotional functioning includes posttraumatic stress symptoms, loss of self-esteem, anxiety, depression, anger, and shame. Two exemplary cases are used to illustrate the themes and underscore the complexities and realities of adjusting to TBI. Recommendations for therapists and consumers are woven throughout the paper.     

Private Practice with a Social Conscience

Abstract

A clinician describes her involvement in a non-profit organization that provides low-cost psychotherapy using the volunteer services of clinical social workers in private practice.     

Breaking Through Barriers

This article presents wilderness therapy for sexual assault survivors. A form of treatment that combines counseling wiht rigorous outdoor activities, it creates situations that relate metaphorically to the original assault. Women engage in activities designed to promote team building, trust, self-esttem, confidence, intimacy and personal growth. They are then faced with physically challenging situations that evoke the feelings of helplessness were experienced during the assault, only this time they are provided with the chance to conquer them, by climbing to the mountaintop, hiking the hill, or simply knowing and asserting their physical limits. This article substantiates wilderness therapeutic programming by looking at its appropriateness for sexual assault behaviors.     

Therapeutic Considerations of Wilderness Experiences for Incest and Rape Survivors

The purpose of this article is to examine the relevancy of traditional wilderness programs, such as Outward Bound, to women who have been violated by experiences of childhood incest and/or adult sexual assault. Applications to African-American women, women with physical challenges, and women who are economically disenfranchised will be emphasized. The overview is from a feminist perspective, one that advocates empowerment over struggle and resisting revictimization on any level. The Rape Assistance and Awareness Program (RAAP) is a non-profit agency in Denver, Colorado dedicated to providing low-cost group psychotherapy for women who have been recently sexually assaulted as well as for women with histories of incest. About five years ago, a three-day Colorado Outward Bound School (COBS) experience was incorporated into RAAP's treatment program. While the COBS weekend generally has been viewed positively by most of the clients and group facilitators, aspects of this element of the program have become increasingly problematic. Its applicability to women with physical disabilities and women with conflicting social and economic priorities is questioned. When RAAP received a special grant to provide sexual assault services specifically targeting women of color, groups for Latinas and African-American women were established and facilitated by therapists of color. These women of color, both clients and therapists, consistently challenge the relevance and practicality for them of the COBS experience. In this article, we contend that wilderness experiences, in their traditional application, do not support the feminist, woman-centered approach to life which is advocated and nurtured at RAAP, nor does it specifically honor cultural diversity or ethnic multiplicity. Recommendations for wilderness experiences attracting a broader range of the feminine experience are made.     

Prevention of Sexual Assault Through the Resocialization of Women

No abstract available for this article.     

The counselling and psychotherapy profession in Canada: regulatory processes and current status

ABSTRACT

Like the Canadian landscape and culture, the status of professional regulation for counselling and psychotherapy is a mosaic reflecting the unique cultural, linguistic and contextual realities of Canada. Statutory regulation in Canada is constitutionally a provincial/territorial matter. In the past five years, a major movement towards professional regulation has emerged. The authors describe the variable status of regulation, focusing on three provinces: Quebec, Nova Scotia and Ontario. They explore the federal Agreement of Internal Trade, designed to facilitate inter-provincial/territorial mobility of regulated professionals. Finally, the authors summarise national research and development activities of the Canadian Counselling and Psychotherapy Association that enhance the pan-Canadian mobility of practitioners and support shared professional understandings. These activities range from bilingual, national validation of competencies, definitions, titles and scopes of practice to symposia and an entry-to-practice competency assessment.     

Disbelief and Trust in Psychoanalysis - A Case Study

A case of unorthodox psychoanalysis with a 27-year-old woman, during the years 1994-1998 is presented. The patient, Silja, suffered from severe character neurosis with depression. She studied humanities at the University of Helsinki with poor results, because of severe inner demands of perfection. The therapy was unorthodox, because it was necessary to change the method a few times. After two years of psychoanalysis, a life-threatening crisis occurred in 1996, and I was obliged to take a more active role and even give direct advice concerning her studies. This was successful, and she could achieve her B.A., the lower university degree. The change of method was necessary to avoid suicide. In the end we could resume psychoanalysis and analyse what had happened. Suddenly in the summer of 1998 Silja's depression disappeared and her looks improved. Therapy ended in November 1998, when she was ready to try on her own. According to her both the holding and love and also the direct advice were the most important elements in her cure. After a three years' follow-up her condition had further improved, she was married, had a job and was expecting a baby.